Delay is Deadly. A Rare Case of Bull Gore Injury with Complete Small Bowel Gangrene

Abstract

Introduction: Blunt abdominal trauma secondary to animal attacks is uncommon but may result in catastrophic intra-abdominal injuries, particularly in rural environments where delayed access to definitive care is frequent. Bull gore injuries, though typically associated with penetrating trauma, may also cause severe blunt visceral ischemia with delayed clinical manifestations.

Case Presentation: We report the case of a 65-year-old male from the Satara district of Maharashtra who sustained blunt abdominal trauma following a bull attack. The patient presented approximately 96 hours after injury with features of generalized peritonitis and septic shock. Initial evaluation revealed hemodynamic instability and laboratory evidence of severe sepsis. Emergency exploratory laparotomy demonstrated complete gangrene of the small intestine with associated ischemic segments of the large bowel, consistent with mesenteric vascular compromise. Extensive bowel resection with stoma formation was performed. Despite aggressive postoperative intensive care, including broad-spectrum antibiotics, vasopressor support, and organ support, the patient developed progressive multiorgan failure and died on postoperative day six.

Discussion: This case highlights the lethal consequences of delayed presentation in blunt abdominal trauma, where evolving mesenteric ischemia may remain clinically silent until irreversible bowel necrosis occurs. Early recognition, prompt imaging, and timely surgical intervention are essential to prevent progression to bowel gangrene and septic shock.

Conclusion: Bull-related blunt abdominal trauma can result in fatal ischemic bowel injury when diagnosis and surgical management are delayed. Enhanced public awareness, early referral pathways, and improved trauma care infrastructure in rural regions are critical to reducing mortality associated with such injuries.